Acral Persistent Papular Mucinosis associated with Multiple Myeloma - Unknown Presentation

The cutaneous mucinosis are a heterogenous group of disorders in which mucin accumulates in the skin. A 66 years old man presented with asymptomatic flesh coloured papules on the extremities without any truncal involvement of 3 months duration. Histopathological examination of a lesional biopsy revealed unremarkable epidermis with dermis showing pallor and loosening of collagen bundles in mucin like deposition suggestive of cutaneous mucinosis. Patient was put on steroids and hydroxycholoroquinine. Three months later he presented with encephalopathy. Investigation revealed hypercalcaemia, reversal of albumin globulin ratio, azotemia. X-ray skull revealed lytic lesions. Bone marrow aspiration and bone marrow biopsy was suggestive of multiple myeloma. This is an unknown presentation, as localized cutaneous mucinosis is not associated with systemic disease. Patient was started on chemotherapy for multiple myeloma. JMS 2012;15(1):74-75.